Can I Have Both Medicare Part B And Employer Insurance?

There may be some confusion regarding Medicare Part B and employer insurance. Can you have both at the same time? The answer is yes, you can have both Medicare Part B and employer insurance, but there are certain things you should know before making a decision.

First, understand that Original Medicare Part B does not replace employer health insurance; it acts as a supplement for additional coverage. Enrolling in Medicare Part B is usually unnecessary for those employed and already have an employer-sponsored health insurance plan. However, it may benefit certain individuals to supplement their existing coverage with Medicare Part B.

For example, if your employer’s health insurance policy does not cover certain medical services that might be covered by Medicare Part B, it may be wise to enroll in Part B. Additionally, employer health insurance policies usually have higher deductibles than Medicare Part B. Therefore, if you plan to pay out of pocket for medical expenses exceeding the deductible on your employer plan, then enrolling in Medicare Part B can help reduce those costs.

How Does Medicare Work If I have Employer Insurance?

When you have Original Medicare and an employer-sponsored health insurance plan, there are rules to determine which payer is responsible for the primary payment. The primary payer will cover its portion of the bills first and then transfer the remaining amount to the secondary payer for payment.

You will then receive a bill for the portion of the claim you are responsible for. To better understand which payer is primary and which is secondary in your particular situation, it is advisable to reach out to your company’s Human Resources department.

Is Medicare Primary Or Secondary To Employer Insurance?

If your company has less than 20 employees, Medicare will be the primary payer, covering your medical expenses first. Conversely, if your company has more than 20 employees, your employer insurance will serve as the primary payer, with Medicare acting as the secondary payer to provide additional coverage for your healthcare costs.

Understanding the synergy between these two plans is crucial in making well-informed choices about your healthcare coverage. As mentioned earlier, contacting your company’s HR department can help clarify any uncertainties.

Do I have to Enroll In Medicare If I have Employer Coverage?

It is important to note that signing up for Medicare is necessary as it does not automatically go into effect once you turn 65. Delaying your Medicare enrollment may result in late fees, so it is advisable to take timely action.

If you receive health insurance from your current employer and qualify for Medicare, you may have to decide between Medicare and your group health plan. Generally, the size of your company determines if you’ll face penalties for not enrolling in Medicare when eligible.

Here are the rules for selecting employer health benefits over Medicare:

  • If your employer has fewer than 20 employees, enrolling in Medicare when eligible is crucial. Not doing so may lead to a late enrollment penalty for Part B if you sign up later, increasing your healthcare costs.
  • If your employer has a workforce of 20 or more employees, you can postpone enrollment without incurring any penalties for late registration. This grants you additional time to carefully evaluate your options and make an informed healthcare decision that best aligns with your needs.

What Happens When I Retire?

If you choose to keep both Medicare and your employer’s health coverage, after retirement, you may need to give up your employer’s health benefits. The duration of this coverage will depend on your employer’s insurance agreement and typically lasts for a few weeks after retirement.

After retiring, you will have a special enrollment period starting one month later. This period spans eight months and allows you to enroll in Medicare Part A and Part B without a penalty.  It also allows you to purchase a Medicare Supplement plan, Medicare Advantage plan, or Medicare Part D for prescription drug coverage. During this time, you have guaranteed issue rights, meaning you can choose a Medigap plan without undergoing medical underwriting requirements.

Bottom Line

While working, Medicare and employer insurance can work together to provide comprehensive healthcare coverage. It is important to understand the rules and regulations that dictate when Medicare or your employer’s plan is the primary payer and how they interact for all your Medicare benefit needs.

Remember that Medicare Part B does not replace employer health insurance; it supplements additional coverage. Consider your health needs, research your plans, and consult a healthcare professional to make the best choice. This step will help you get the most out of your Medicare and employer insurance plans.

Sources: Medicare.Gov


Mark Prip

Since 2003, Mark Prip has been leading  Policy Guide, Inc., providing knowledgeable information about Medicare, life insurance, and dental coverage to clients in over forty states. With his unparalleled hands-on experience aiding countless Medicare beneficiaries in selecting an appropriate health plan, he is a prime example amongst other competitors for expertise and assistance. Mark has held his Florida Health & Life Insurance License (E051889) since 2003. View his license profile on the Florida Department of Insurance website.